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Medical Coding Specialist, Sr.

Salary: $20.58-$25.12 hourly / $3,579-$4,369 monthly / Range: 5396

DEFINITION: Under general direction, leads the medical coding function in the Public Health Department; ensures departmental compliance with applicable laws and regulations; and performs other related duties as assigned.

DISTINGUISHING CHARACTERISTICS: This single-position classification is distinguished from the Medical Coding Specialist by its leadworker responsibilities and by its responsibility to systematically review departmental policies and procedures to ensure that the department remains in compliance with applicable laws and regulations, and to reduce the costs associated with denied bills.

EXAMPLES OF DUTIES:

1. Acts as a leadworker over the medical coding function; provides training, mentoring, and direction to medical coding staff in the Fiscal division and in the Public Health Department clinics; reviews the work of other medical coding staff to ensure compliance with departmental policies and other applicable laws and regulations; identifies patterns of improper coding and resolves problems and issues.
2. Serves as the Public Health Department's Compliance Officer; reviews current policies and makes recommendations for changes to bring policies into compliance; creates written procedures and implements changes through communication with and training of medical coding and clinic staff; designs, documents, and maintains a system for providing quality control feedback to medical coding and clinic staff.
3. Reviews medical coding trends and identifies potential training needs and/or performance problems; develops and provides training on medical coding requirements including ICD-9, CPT, FQHC, Medicare, Medi-Cal, Pact, and others; collaborates with clinic supervisors to ensure clinic staff receive adequate training and to resolve any identified performance problems.
4. Stays abreast of current coding issues and changes; documents and communicates changes to department staff and provides training as required; maintains and updates department Charge Description Master file, bills and rates, including updating charge tickets to reflect changes in business practices.
5. Educates physicians and other health care practitioners to improve accuracy of chart coding; advises them on proper code selection, required documentation, procedures, and other requirements; identifies performance issues and brings them to the attention of the appropriate supervisor.
6. Evaluates medical record and charge ticket coding to optimize reimbursement, and ensure legal compliance and accuracy in billing and medical documentation for private and government programs; identifies areas that would permit enhanced reimbursement and reduce denials of claims.

EMPLOYMENT STANDARDS: Possession of a Registered Health Information Administrator certificate (RHIA), a Registered Health Information Technician (RHIT) certificate, a Certified Coding Specialist-Physician Based (CCS-P), or Certified Procedural Coder certificate (CPC); and,

1. Three years of experience as a medical coder in a large outpatient services environment; or,
2. three years of experience performing duties equivalent to a Medical Coding Specialist with Santa Barbara County; or,
3. a combination of training, education, and experience that is equivalent to one of the employment standards listed above and that provides the required knowledge and abilities.

Knowledge of: Common Procedural Terminology (CPT), International Classification of Diseases (ICD-9), and Health Care Procedural Coding System (HCPCS) coding; documentation guidelines for medical service provision, patient case management, follow-up, and billing; Local Medical Review Policies (LMRP) for Medicare and Medi-Cal ancillary services; Medical terminology and abbreviations; Medicare and Medi-Cal programs including medical documentation, covered services, billing regulations, and eligibility of physicians and patients; standard office computer software; standard English usage and grammar.

Ability to: research and analyze data, draw conclusions, and resolve issues; read, interpret, and apply policies, procedures, laws, and regulations; read and interpret medical procedures and terminology; work independently; review and comment on the work of others; maintain confidentiality; maintain effective working relationships with physicians and other staff; prepare reports and related documents; direct the work of others; write in a clear and understandable manner; exercise independent judgment; influence and coordinate the efforts of others over whom one has no direct authority.
 



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